(Sacramento, CA)—California Association of Nurse Anesthesiology (CANA) President Sandra Bordi, DNP, CRNA, FAANA today issued the following statement regarding CRNAs’ independent practice authority in California:

“The California Association of Nurse Anesthesiology commends the California Department of Public Health (CDPH) for maintaining the precedent set forth by California Society of Anesthesiologists v. Superior Court and Business & Professions Code Section 2725 in their All Facilities Letter released on September 6, 2024.

“The AFL clarifies, among other matters, that CRNAs do not require physician supervision in California and that the Nursing Practice Act gives CRNAs legal authority to provide all direct and indirect patient services related to anesthesia care.

“Unfortunately, despite the AFL’s clarifications of existing state and federal law and regulations, false statements about CRNAs’ scope continue to decimate care in underserved regions of the state. Therefore, we are immediately calling on the California Board of Registered Nursing and the CDPH to better protect the public by providing clear guidance to hospitals about CRNAs’ independent authority. This guidance must include the fact that once a provider schedules a treatment regimen that includes anesthesia, both physician anesthesiologists and CRNAs are allowed to independently administer anesthesia care and services in the same way, as well as the fact that the 2012 court decision makes it clear that an ‘order’ does not imply ‘supervision’ or ‘direction.’

“Of note, anesthesia services are not limited to medication administration alone. These services are delivered during the perianesthesia time period, which includes pre-operative, intra-operative, and post-operative care. Anesthesia also encompasses services performed outside of the perioperative setting of an acute care facility, including, but not limited to, offices, clinics, and outpatient surgery settings. An order or directive entered on the chart or medical record of a patient registered in the hospital is authorization for the CRNA to select the type of anesthesia for the patient, to abort or modify the type of anesthesia for the patient during the course of care, and to select and administer medications related to the anesthesia services provided.

“For decades, CRNAs have routinely and regularly provided safe, effective, and cost-efficient anesthesia care in California. CANA and our legislative champions are committed to protecting patient access to timely and high-quality anesthesia services, whether the services are led by a CRNA or in collaboration with a physician anesthesiologist. We request the BRN and CDPH immediately follow suit by providing clear guidance regarding CRNAs’ independent authority in California.”

About California Association of Nurse Anesthesiology (CANA)

CANA is the definitive source of leadership, advocacy, and education for certified registered nurse anesthetists (CRNAs) in California. Since 1931, CANA has worked to advance patient safety, foster access to the highest quality anesthesia, and support the nurse anesthesia profession in California. Learn more by visiting www.canainc.org.

California state law has allowed certified registered nurse anesthetists to practice independently since the 1980s. In 2009, then-Gov. Arnold Schwarzenegger codified their ability to bill Medi-Cal as licensed independent providers to ensure all Californians had access to high-quality anesthesia care no matter a patient’s zip code.

Countless studies find certified registered nurse anesthetists as safe and effective as physician anesthesiologists, including when practicing independently and in complex cases.

Unfortunately, a long-standing, disingenuous campaign to discredit advanced practice providers — including nurse practitioners, nurse midwives and certified registered nurse anesthetists — has put Central Valley hospitals in the cross-hairs.

These hospitals have been unfairly targeted by a physician anesthesiologist-led surveyor contracting with the California Department of Public Health who incorrectly told hospital administrators that California state law did not allow for certified registered nurse anesthetists to practice without physician supervision. The surveyor then went on to threaten harsh sanctions should the hospitals not change their anesthesia care teams accordingly.

As a result — and before these hospitals even received potential corrective actions from the state — hospital administration unfairly and unnecessarily laid off or fired dozens of certified registered nurse anesthetists.

Making the situation far worse is the ripple effect these surveys have caused. By creating a false impression that anesthesia practice by certified registered nurse anesthetists, unless under physician supervision, is unsafe and unlawful, the Department of Public Health survey team overstepped multiple regulatory bodies, including the only state entity with oversight of and governance responsibility for certified registered nurse anesthetists, jeopardized the care these hospitals can provide now and in the future and caused needless chaos for residents throughout the Central Valley — an already under-served region struggling to recruit and retain providers.

For decades, rural counties in California have relied on certified registered nurse anesthetists to provide anesthesia care, with four counties solely relying on certified registered nurse anesthetists: Colusa, Lassen, Modoc and Trinity. We are deeply concerned that if the state Department of Public Health allows this rogue surveyor to continue, patients throughout the state (especially in these four counties) will be negatively impacted.

Unfortunately, the California Department of Public Health doesn’t share our concern for patient safety and well-being.

The physician anesthesiologist association leadership’s goal is to return California to a physician-supervision state where every facility is required to hire at least one physician anesthesiologist to sign off on the care led, directed and provided by certified registered nurse anesthetists.

These are physicians more concerned about “scope-creep” and the perceived competitive threat of certified registered nurse anesthetists than improving patient health and safety. So, rather than putting them to task for addressing the disastrous provider shortage in the state, the state Department of Public Health has sided with a small cadre of physicians who would rather make things worse by reducing the number of qualified providers available to practice in California.

As hospitals close left and right, improved access to all qualified providers is imperative. Fortunately, state legislators are taking action to counteract the inaction of state public health leadership.

On June 18, Asm. Heath Flora, R-Ripon, Asm. Juan Alanis, R-Modesto and Sen. Marie Alvarado Gil, D-Jackson, requested an immediate investigation into the surveyor and their actions.

“Given the scope of practice for certified registered nurse anesthetists and the impact this survey team is having on access to medical services in the Stanislaus County region, we are alarmed at the lack of action thus far by the California Department of Public Health to investigate and correct the actions of this survey team,” the public officials stated in a letter to the California Department of Public Health.

The real story in Modesto has nothing to do with patient safety or legally certified registered nurse anesthetists’ practice. Residents, legislators and certified registered nurse anesthetists deserve to know why the Department of Public Health hired an openly biased surveyor and scared hospitals into needlessly changing their anesthesia practices.

Forced to sideline chosen anesthesia teams, impacted hospitals have had to cancel nearly 1,000 surgeries in the past few weeks alone, with more than 80% being Medicare and Medi-Cal patients. In turn, Central Valley residents have been deprived of accessible, high quality, affordable healthcare procedures.

We call on the state to stop the unjustified attack on certified registered nurse anesthetists. Central Valley residents and Californians should once again benefit from timely, safe, effective anesthesia care.

Read more at: https://www.modbee.com/opinion/opn-columns-blogs/community-columns/article289941964.html#storylink=cpy